High Blood Pressure Medicine And Drugs

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High Blood Pressure Medicine And Drugs:
Many people need to take a combination of medications to effectively treat their hypertension.

While some blood pressure medicines work by removing extra fluid and salt from your body to lower blood pressure, others slow down your heartbeat or relax and widen blood vessels.

For many people, taking more than one medication in low doses is more effective in treating hypertension than taking larger doses of one single drug.

Sometimes your doctor may need to try different combinations of drugs before determining which is best for you.

Depending on your body, medical history, and severity of hypertension, your doctor may recommend one or more of the following medications.

Thiazide Diuretics: Also called water pills, diuretics are usually the first medication a doctor will prescribe to treat high blood pressure.

Diuretics work by getting your kidneys to help your body eliminate sodium and water, reducing blood volume.

Beta Blockers: By acting on the electrical circuitry and muscle fibers in the heart, beta blockers cause your heart to beat slower and with less force.

Although they aren't always effective in lowering blood pressure when prescribed alone, they have been found helpful when combined with other blood pressure medications.

Angiotensin-Converting Enzyme Inhibitors (ACE Inhibitors): By blocking the formation of a natural chemical that narrows blood vessels, ACE inhibitors help relax blood vessels.

These medications may be effective for people with chronic kidney disease.

Angiotensin II Receptor Blockers (ARBs): By blocking the action of a natural chemical that narrows blood vessels, these medications help relax blood vessels.

ARBs may be effective for people with chronic kidney disease.

Calcium Channel Blockers: These work by helping to relax the muscles of your blood vessels, and some slow your heart rate.

Calcium channel blockers may work better for older people and African-Americans than ACE inhibitors alone.

Take note that grapefruit juice interacts with some calcium channel blockers, which increases blood levels of the medication and puts you at higher risk of side effects.


Renin Inhibitors: Tekturna (aliskiren) slows down the production of renin, which is an enzyme produced by your kidneys that initiates a chain of chemical steps that increases blood pressure.

Tekturna works by reducing the ability of renin to begin this process.

It's important to note that you shouldn't take aliskiren with ACE inhibitors or ARBs because this would put you at risk for serious complications, including a stroke.

Alpha Blockers: By reducing nerve impulses to blood vessels, alpha blockers reduce the effects of natural chemicals that narrow blood vessels.

Alpha-beta Blockers: Like alpha blockers, these medications reduce nerve impulses to blood vessels, but they also slow the heartbeat to reduce the amount of blood that's required to pump through the vessels.

Central-Acting Agents: These medications work by preventing your brain from signaling your nervous system to increase your heart rate and narrow your blood vessels.

Vasodilators: By working directly on the muscles in the walls of your arteries, vasodilators prevent the muscles from tightening and your arteries from narrowing.

Aldosterone Antagonists: These drugs block the effect of a natural chemical that can lead to salt and fluid retention, which can contribute to high blood pressure.

Aspirin: When you've got your blood pressure under control, your doctor may recommend that you take aspirin once a day to reduce your risk of cardiovascular disorders.

What if I Can't Control my Blood Pressure?

If you've taken at least three different types of high blood pressure medication, and one includes a diuretic, yet your blood pressure still remains high, your blood pressure may be resistant to treatment.

When this occurs, doctors label it as resistant hypertension.

People who need to take four different medications to keep their blood pressure under control are also considered to have resistant hypertension.


If you have resistant hypertension, however, that doesn't mean your blood pressure will never get lower.

You and your doctor may have to consider the following to try to lower your blood pressure:

Whether you've tried appropriate medications and doses
Ways to fine-tune your medications to come up with the most effective combination and doses
Whether medications you take for other conditions, foods you eat, or supplements you take are interacting with your high blood pressure
If you haven't taken your blood pressure medications exactly as directed

If you've skipped doses for reasons including you forgot, can't afford the medication, or get unpleasant side effects

Drugs Of High Blood Pressure

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High Blood Pressure Drugs:

Your doctor or practice nurse will advise on the target blood pressure level to aim for. It can vary from person to person. In general:

For most people aged under 80 years, the usual target is to reduce blood pressure to 140/90 mm Hg or below in the surgery or clinic, or below 135/85 mm Hg when measured at home. For older patients the target may be set slightly higher (less than 150/90 mm Hg in the surgery or clinic, or below 145/85 mm Hg when measured at home).
In some people, the target is to get it below 130/80 mm Hg. For example, if you have a cardiovascular disease such as a stroke or heart disease, if you have certain kidney diseases, and for some people with diabetes.

Which medicines are used to lower blood pressure?
There are five main classes of medicines that are used to lower blood pressure. There are various types and brands of medicine in each class. The following gives a brief overview of each of the classes. However, for detailed information about your own medication you should read the leaflet that comes inside the medicine packet.

Angiotensin-converting enzyme (ACE) inhibitors
ACE inhibitors work by reducing the amount of a chemical that you make in your bloodstream, called angiotensin II. This chemical tends to narrow (constrict) blood vessels. Therefore, less of this chemical causes the blood vessels to relax and widen, and so the pressure of blood within the blood vessels is reduced.

There are various types and brands of ACE inhibitors: captopril, enalapril, fosinopril, lisinopril, perindopril, quinapril, ramipril, and trandolapril. An ACE inhibitor is particularly useful if you also have heart failure or diabetes. ACE inhibitors should not be taken by people with certain types of kidney problems, people with some types of artery problems, and those who are pregnant. You will need a blood test before starting an ACE inhibitor. This will check that your kidneys are working well. The blood test is repeated within two weeks after starting the medicine, and within two weeks after any increase in dose. Then, a yearly blood test is usual.

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Angiotensin receptor blockers
These medicines are sometimes called angiotensin-II receptor antagonists. There are various types and brands: candesartan, eprosartan, irbesartan, losartan, olmesartan, telmisartan and valsartan. They work by blocking the effect of angiotensin II on the blood vessel walls. So, they have a similar effect to ACE inhibitors (described above).

Calcium-channel blockers
Calcium-channel blockers affect the way calcium is used in the blood vessels and heart muscle. This has a relaxing effect on the blood vessels. Again, there are various types and brands: amlodipine, diltiazem, felodipine, lacidipine, lercanidipine, nicardipine, nifedipine, and verapamil. Calcium-channel blockers can also be used to treat angina.

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'Water' tablets (diuretics)
Diuretics work by increasing the amount of salt and fluid that you pass out in your urine. This has some effect on reducing the fluid in the circulation, which reduces blood pressure. They may also have a relaxing effect on the blood vessels, which reduces the pressure within the blood vessels. The most commonly used diuretics to treat high blood pressure (hypertension) in the UK are thiazides or thiazide-like diuretics. Examples are bendroflumethiazide, chlortalidone, cyclopenthiazide, and indapamide. Only a low dose of a diuretic is needed to treat high blood pressure. Therefore, you will not notice much diuretic effect (that is, you will not pass much extra urine). You will need a blood test before starting a diuretic, to check that your kidneys are working well. You should also have a blood test within 4-6 weeks of starting treatment with a diuretic, to check that your blood potassium has not been affected. Then, a yearly blood test is usual.

Beta-blockers
Again, there are various types and brands of beta-blockers: acebutolol, atenolol, bisoprolol, metoprolol, oxprenolol, pindolol, propranolol, sotalol, and timolol. They work by slowing the heart rate, and reducing the force of the heart. These actions lower the blood pressure. Beta-blockers are also commonly used to treat angina, and some other conditions. You should not normally take a beta-blocker if you have asthma, chronic obstructive pulmonary disease (COPD), or certain types of heart or blood vessel problems.

Decision aids
Doctors and patients can use Decision Aids together to help choose the best course of action to take.
Compare the options
What about side-effects?
All medicines have possible side-effects, and no medicine is without risk. However, most people who take medicines to lower blood pressure do not develop any side-effects, or only have mild side-effects. A full list of cautions and possible side-effects is listed on the leaflet inside the medicine packet. The most common ones are:

ACE inhibitors - sometimes cause an irritating cough.
Angiotensin receptor blockers - sometimes cause dizziness.
Calcium-channel blockers - sometimes cause dizziness, facial flushing, swollen ankles, and constipation.
'Water' tablets (diuretics) - can cause gout attacks in a small number of users, or can make gout worse if you already have gout. Erection problems (impotence) develop in some users.
Beta-blockers - can cause cool hands and feet, poor sleep, tiredness, and impotence in some users.
If you do develop a side-effect, a different medicine may suit you better. There is a lot of choice so one can usually be found to suit. See your doctor if you develop any problem which you think is due to your medication.

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How to use the Yellow Card Scheme
If you think you have had a side-effect to one of your medicines you can report this on the Yellow Card Scheme. You can do this online at the following web address: www.mhra.gov.uk/yellowcard.

The Yellow Card Scheme is used to make pharmacists, doctors and nurses aware of any new side-effects that medicines or any other healthcare products may have caused. If you wish to report a side-effect, you will need to provide basic information about:

The side-effect.
The name of the medicine which you think caused it.
The person who had the side-effect.
Your contact details as the reporter of the side-effect.
It is helpful if you have your medication - and/or the leaflet that came with it - with you while you fill out the report.

Other medicines for high blood pressure
Apart from the five main classes of medicines listed above, sometimes other medicines are used to lower blood pressure. For example, methyldopa or alpha-blockers are sometimes used if there are problems with the more commonly used medicines.

Combinations of medicines
One medicine can reduce high blood pressure (hypertension) to the target level in less than half of cases. It is common to need two or more different medicines to reduce high blood pressure to a target level. In about a third of cases, three medicines or more are needed to get blood pressure to the target level. So, for example, you may need an ACE inhibitor plus a calcium-channel blocker (and sometimes also another medicine) to control your blood pressure. This is just an example, and various combinations of medicines can be used.

In some cases, despite treatment, the target level is not reached. However, although to reach a target level is ideal, you will gain benefit from any reduction of high blood pressure.

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So, which is the best medicine or combination of medicines?
The one or ones chosen may depend on such things as:

Whether you have other medical problems.
Your ethnic origin.
Whether you take other medication.
Possible side-effects.
Your age.
For example:

Beta-blockers and calcium-channel blockers can also treat angina.
ACE inhibitors also treat heart failure.
Some medicines are not suitable if you are pregnant.
Some medicines are thought to be better if you have diabetes.
Some medicines tend to work better than others in people of Afro-Caribbean origin.
If you do not have any other medical problems that warrant a particular medicine then current UK guidelines give the following recommendations as to usual medicines that should be used. These recommendations are based on treatments and combinations of treatments that are likely to give the best control of the blood pressure with the least risk of side-effects or problems.

Treatment is guided by the A/C, A+C, A+C+D approach, where A = ACE inhibitor or angiotensin receptor blocker; C = calcium channel blocker and D = diuretic. The suggested stepwise approach is as follows:

If you are less than 55 years old and are not of black African or Caribbean origin then your doctor may begin treatment with an 'A' (an ACE inhibitor, or an angiotensin receptor blocker if an ACE inhibitor causes problems or side-effects).
If you are 55 years or older, or are of black African or Caribbean origin then your doctor may begin treatment with a 'C' (a calcium-channel blocker).
Then, if your blood pressure has not reached the target your doctor may combine 'A' with 'C' (an ACE inhibitor or an angiotensin receptor blocker plus a calcium-channel blocker).
Then, if your target blood pressure is still not reached, your doctor may combine 'A' with 'C' and 'D' (an ACE inhibitor or an angiotensin receptor blocker, and a calcium-channel blocker, and a diuretic).
If a fourth medicine is needed to achieve the target blood pressure, your doctor may add one of the following:
A beta-blocker
Another 'water' tablet (diuretic)
An alpha-blocker
However, individuals can vary. Sometimes, if one medicine does not work so well or causes side-effects, a switch to a different class of medicine may work fine.

How long is medication for high blood pressure needed for?

In most cases, medication is needed for life. However, in some people whose blood pressure has been well-controlled for three years or more, medication may be able to be stopped. In particular, in people who have made significant changes to lifestyle which can affect blood pressure (such as lost a lot of weight, or stopped heavy drinking, etc). Your doctor can advise. If you stop medication, you need regular blood pressure checks. In some cases, the blood pressure remains normal. However, in others it starts to rise again. Medication can then be started again.